晚期非小细胞肺癌患者免疫治疗所致甲状腺功能减退症的中医证候、证素特点研究  

Study on the Characteristics of Traditional Chinese Medicine Syndrome and Syndrome Elements of Hypothyroidism Induced by Immunotherapy in Patients with Advanced Non-Small Cell Lung Cancer

作　　者：张文静 梁展鹏 张奡 陈婷 张华堂 方灿途 李陆振 ZHANG Wenjing;LIANG Zhanpeng;ZHANG Ao;CHEN Ting;ZHANG Huatang;FANG Cantu;LI Luzhen(Zhongshan Hospital of Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine,Zhongshan 528400 Guangdong,China;Yunmeng People's Hospital,Xiaogan 432500 Hubei,China)

机构地区：[1]广州中医药大学附属中山中医院,广东中山528400 [2]云梦县人民医院,湖北孝感432500

出　　处：《广州中医药大学学报》2025年第2期283-292,共10页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：广东省中医药局科研项目(编号:20231377)。

摘　　要：【目的】探索晚期非小细胞肺癌(NSCLC)患者接受免疫检查点抑制剂(ICIs)治疗后出现甲状腺功能减退症(以下简称“甲减”)的中医证候特点、证素分布与组合情况以及中医证型的分布规律。【方法】选择2020年1月至2023年6月就诊于广州中医药大学附属中山中医院,经病理确诊为ⅢB-ⅣB期、表皮生长因子受体/间变性淋巴瘤激酶(EGFR/ALK)阴性、并使用ICIs治疗后出现甲减的NSCLC患者,共168例。收集患者的四诊信息,运用聚类分析总结出晚期NSCLC免疫治疗后出现甲减的中医证候特点和证型分布规律,并对不同性别、年龄段和甲减分级的中医证型分布规律进行分析。【结果】(1)168例晚期NSCLC患者接受免疫治疗后出现甲减的中医证候以虚为主,表现为咳嗽、倦怠乏力、健忘、面色少华、自汗、皮肤干燥、痰色白、懒言、头晕、夜尿多、视物模糊、形体消瘦、皮肤弹性差、纳呆恶食、嗜睡、长期食少、水肿、失眠、声低、隐痛、指甲淡白、吐痰、经常畏冷、口渴、面色?白、喜温恶凉、渴欲热饮、气喘、经常便秘、大便干结、面睑浮肿、多梦、腹胀、腰痛、排便无力等;舌脉象主要包括:舌苔薄白、舌淡红、舌边齿印、舌淡胖、舌淡、脉沉、脉滑、脉虚、尺脉弱、脉细。(2)总体病位证素以肺、脾、肾多见,病性证素以气虚、阳虚、血虚、水停多见。(3)经聚类分析,得出以下3种证型,分布频次由高到低依次为肺脾气虚证、肾阳亏虚证和气虚水停证。(4)不同年龄段的中医证型分布比较,差异有统计学意义(P<0.01)。其中,60~69岁患者以肺脾气虚为主要证型,≥70岁患者以肾阳亏虚为主要证型,<50岁患者以气虚水停证为主要证型。而不同性别、甲减等级的中医证型分布比较,差异均无统计学意义(P>0.05)。【结论】晚期NSCLC免疫治疗所致甲减患者的中医证型以肺脾气虚、肾阳亏虚、气�Objective To explore the characteristics of traditional Chinese medicine(TCM)syndrome,syndrome elements and their combination,and the distribution of TCM syndrome types in advanced non-small cell lung cancer(NSCLC)patients suffering from hypothyroidism after treatment with immune checkpoint inhibitors(ICIs).Methods The analysis was conducted on 168 patients with NSCLC at stageⅢB-ⅣB confirmed by pathological findings,whose epidermal growth factor receptor/anaplastic lymphoma kinase(EGFR/ALK)was negative,and then suffering from hypothyroidism aftertreatment with ICIs from January 2020 to June 2023,who admitted to Zhongshan Hospital of Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine.The patients'information collected by four diagnostic methods of TCM was analyzed,and then cluster analysis was used to explore the characteristics of TCM syndrome and the distribution of TCM syndrome types of immunotherapy-induced hypothyroidism in advanced NSCLC.Moreover,the distribution of TCM syndrome types in the patients with different genders,age groups,and hypothyroidism grades was analyzed.Results(1)The TCM syndrome of hypothyroidism appearing in 168 patients with advanced NSCLC after immunotherapy was characterized by deficiency type,which manifested as follows:cough,fatigue and weakness,amnesia,lusterless complexion,spontaneous sweating,dry skin,white sputum,unwilling to talk,dizziness,nocturnal polyuria,blurred vision,emaciation,poor skin elasticity,poor appetite or even anorexia,somnolence,long-term poor appetite,edema,insomnia,low voice,dull pain,light white color of fingernails,spitting,frequently intolerance of cold,thirst,bright pale complexion,preference of warmth and aversion to cold,thirst with preference of hot drink,dyspnea,frequent constipation,dry stools,puffiness of face and eyelid,dreaminess,abdominal fullness,lumbar pain,and weakness in defecation.The tongue manifestation and pulse condition were characterized by white and thin coating,pale-red tongue,tongue with tooth-marks,pale and

关 键 词：晚期非小细胞肺癌 免疫治疗 甲状腺功能减退症 中医证候 肺脾气虚证 肾阳亏虚证 气虚水停证 

分 类 号：R273.342[医药卫生—中西医结合]